Where scars are already present there is no more efficient application for them than a sharp spark from the glass electrode, or a very mild spark from the fulguration point may be employed.
    Actinomycosis (Ray Fungus). In this disease the high frequency spark is employed as an adjunct to the X-ray. The spark should be from one-quarter to three-quarters of an inch in length, according to the toleration of the patient, providing the vacuum tube is used. If the fulguration point is employed, a shorter spark is required. Three treatments per week.
    Adenitis, Cervical (See Tuberculosis of Glands).
    Adhesions. Where pelvic or other adhesions follow operations or inflammatory conditions, the high frequency current will be useful. The vacuum tube is employed, using an intensity capable of producing a one-half inch spark and keeping the tube in light contact with the abdominal wall, passing back and forth over the area involved for from seven to ten minutes, or use the indirect spark with patient on auto-condensation pad. In pelvic adhesions, the use of the vacuum electrode in the vagina in connection with the surface application will hasten results. Mechanical vibration is advised in connection.
    Albuminuria (Nephritis; Bright's Disease). Benefit in these diseases has been obtained from the application of high frequency currents. The best method is the use of auto-condensation, 2,500 to 7,500 E. per day, in connection with the use of a vacuum tube over the region of the kidneys. There have been many reports of the disappearance of the albumen following this method of treatment. I have myself seen both albumen and casts disappear, but do not wish to be understood as making the statement that this treatment will cure Bright's Disease. That it is of sufficient value to warrant its employment, if possible, in every case, is my firm belief, particularly in cases where high blood pressure exists. This is always the case in chronic interstitial nephritis, as high pressure in the renal artery is apparently the primary cause of the disease. (See Arteriosclerosis.) Auto-condensation in these cases will lower the blood pressure and by relieving the pressure in the kidney, the strain is taken off the filtering tubules and the result is at least beneficial even if not necessarily curative. High frequency in this disease must be considered solely as an adjunct to our usual routine treatment and should not be looked upon as taking the place of these measures.
    Alcoholism. Use of the vacuum tube over the spine, solar plexus and to the extremities in connection with other means to overcome the effects of alcoholism, has been advised by several operators. If the blood pressure is high, the spinal application would be contra-indicated and auto-condensation or auto-conduction should be substituted. The latter forms are also specially sedative where nervous excitement is present. (See Drug Addiciions.)
 

    Anemia and Chlorosis. As high frequency currents increase the oxygenation of the blood, thereby increasing both the reduction of oxyhemoglobin and also the number of red corpuscles and the percentage of hemoglobin, their employment in anemia, especially of the chlorotic type, is quite as effective as iron tonics, and at the same time does not interfere with the joint use of the latter. The method of administering the current is by auto-condensation. If the blood pressure is normal or above, give 2,500 to 7,500 E. three to six times per week. If the blood pressure is below normal give 1,000 to 1,250 E. with meter reading about 250 for low amperage machines, and 500 for high amperage outfits.
    Ozone inhalations are clearly indicated and are of the utmost value in these cases. In one of my cases the percentage of hemoglobin increased from thirty per cent to eighty per cent in eight weeks. Intra-muscular injections of iron solutions are advised.
    Aneurism. Auto-condensation, 2,500 to 5,000 E., three to six times per week gives relief but is, of course, not curative. Under no circumstances should the vacuum electrode be employed locally over the aneurism.
    Appendicitis, Catarrhal. In catarrhal appendicitis, the vacuum tube has been employed locally, using a tube capable of emitting a one-fourth or one-half inch spark, keeping it moving in contact with the skin over the region of the appendix. Both the monopolar application from the resonator or Tesla, and the bi-polar Tesla current have been employed. In the latter case, the other pole is placed over the lumbar region, or grounded by attachment to gas or water pipe. It is my opinion that appendicitis, in any form, is a disease which high frequency operators should not trifle with, but turn over to their surgical friends.
    Arteriosclerosis and High Blood Pressure. Arteriosclerosis is a disease that is of the utmost importance, because it is the primary condition which results in so many diseases of kidneys, liver, heart and brain, which we are accustomed to classify according to the organ more particularly affected. Arteriosclerosis, formerly looked upon as the heritage of old age, is now very common and greatly on the increase because of our present mode of life with its strenuous efforts to gratify ambition; its excesses and indiscretions in eating, drinking, etc. Today there are many men young in years whose arteries are those of the octogenarian and forecast the probability of a sudden termination of their usefulness.
    The most prominent and persistent symptom of arteriosclerosis is high blood pressure. The circulatory system may be compared to an electrical plant, in which the heart is the central station or dynamo and must necessarily have a pressure sufficient to overcome the resistance in the circuit. Therefore, we have the pressure decreasing in the arteries, less in the capillaries, and still decreasing as the veins grow larger. Thus we have the complete round of the circulation, the blood following the rule of water and of electricity and flowing from a higher to a lower pressure. Normal pressure of the blood in the arteries is sufficient to support a perpendicular column of mercury of from 110 to120 millimeters. In arteriosclerosis it sometimes increases to over 300.
    The disease is usually divided into the functional and organic stages. The first would be the stage previous to the real hardening of the arteries and the latter that in which structural changes actually had occurred.
    In the functional stage there comes to be present a contracted condition of the artery, producing thereby increased tension and raising the blood pressure. At this time this is the result of irritation and spasm on the part of the muscular fibres and no actual degeneration or permanent change in structure has appeared. Thus the disease develops gradually and without any particularly noticeable or alarming early symptoms. The theory is that toxins in the blood first cause irritation, then contraction or spasm of the arteries, which may be intermittent, but become a more or less steady contraction, increasing the pressure by narrowing the caliber of the artery and finally attaining the permanent changes of the second stage. The causes producing the original irritation are gout, uric acid, lead poisoning, syphilis, diabetes, excesses or abuses in eating, drinking, tobacco, etc. There is faulty conversion of food products into living cells with failure to properly eliminate poisons from the system and the absorption of the products of imperfect intestinal digestion (auto-intoxication).
    Of the errors in diet, the most common is the consumption of too much nitrogenous food, especially red meats and substances rich in proteids. Other causes of arteriosclerosis are worry; prolonged mental or muscular strain, and the after effects of infectious diseases. Although more common after the age of forty, no period of life is exempt; cases occurring at the ages of eight, fifteen and twenty-eight years being on record. Whatever the treatment undertaken for the disease, there must necessarily be a regulation of habits to overcome the causes stated above. The diet should be simple, all alcoholic beverages tabooed; tobacco should be prohibited or used sparingly. Milk or buttermilk are allowed, especially the buttermilk made with lactic acid ferments. Red meats are to be eaten sparingly, but plenty of vegetables are advised.
    There has been a tendency on the part of many physicians toward the partial or complete elimination of salt from the diet. The individual should take his time, and avoid all worry, haste and excitement. In addition, strict attention should be given to personal hygiene and regular but moderate exercise, baths, etc. It has been shown experimentally that in a normal subject, the blood pressure may be raised from five to ten millimeters by taking a cup of beef broth. Therefore, the necessity for curtailing the amount of red meat is apparent.
    One of our Chicago millionaires consulted two celebrated German specialists, Dr. Grodel of Nauheim and Dr. Vogel of Ems. The directions given by each were almost identical, and I herewith give the combined list:

    "Two cigars daily, separately. Coffee, three-fourths milk, or dekafa. Chocolate. No tea. No Turkish baths. Swimming all right. Horse-back riding; slow horse. Slow golf. Automobiling all right. No stairs; no strain; no hurry. Eat coarse graham bread like Nauheim. Never over-eat, it kills! No sweets. No cabbage, fresh bread or foods causing flatulence. Champagne and wines do the same (cause flatulence). Eat lightly and more often if necessary."

    Although high blood pressure is the rule, if the heart is dilated and there is a tendency to dropsy and congestion, there may be a low blood pressure. In these cases it is necessary to be sure of the pulse pressure. (See Chapter VI under "Taking Blood Pressure."). The most important and constant symptom, however, is high blood pressure. In Figs. 44 and 44a the process of taking the blood pressure is illustrated. (For the technique of taking the blood pressure, see Chapter VI.)
    The electrical treatment of arteriosclerosis is the use of the high frequency current by auto-conduction or by auto-condensation. The preliminary dose is 2,500 E., and it should be given daily in the beginning, and less than three treatments a week at the start are useless.
    As the blood pressure approaches normal, the treatments may be reduced to three a week, then to twice a week, and if there is no tendency to a rise in pressure, then once a week. A treatment every week or two should be maintained for some time in order to be sure of the permanency of results. It is not enough to force the pressure down and then suddenly abandon all treatment. It will require on an average about 40 to 50 treatments to bring the pressure from 200 down to 140 or under, or to the point where only one treatment a week is needed.
    The pressure is taken before giving the treatment and if taken after shows an average reduction of about 10 to 12 millimeters. In a few hours the pressure is back nearly to where it was before, the net reduction being from one-half to two millimeters, according to the individual and the degree of pressure. When the pressure is over 200 I expect to get a net reduction of two millimeters for each treatment. Between 200 and 160 I look for an average of one and one-half points, while below 160 it will be from one down to one-half millimeter. In some cases it goes down steadily for 10 to 15 points, and then remains stationary for a week or two, and then down another series.
    Dr. John Ritter of Chicago has shown that the blood pressure, like the pulse, varies with the position of the patient, whether standing, sitting or lying down. Therefore, it should be taken on subsequent occasions with the patient in the same position.
    It should not be taken too often, say, once a week, as otherwise the gain is not specially noticeable.
    Occasionally, just as the pulse had been cut off by the pressure on the brachial artery and I had noted the systolic reading, the pressure would go up five, ten or twenty millimeters. This I have attributed to a spasm taking place in the brachial artery from too frequent taking of the pressure.
    At the end of ten treatments, if the blood pressure is not reducing in accordance with the rate given above I increase the length of the treatments, about one-half (3,750 E.), but do not increase the meter readings. After another ten treatments, if the reduction is insufficient, I lengthen the time to twice the original (making 5,000 E.), and so I keep crowding the dose until I get results or convince myself that it is impossible. Many operators fail because afraid to push the dose.
    When taking the pressure, take both systolic and diastolic, and note their difference, pulse pressure.
    In these cases we are only interested, as a rule, in low pulse pressure, and this should never remain long under 20. If it does we have carried auto-condensation as far as it will do any good, and it must be stopped, as further treatment will entirely disturb compensation and endanger the patient.
    Ordinarily the systolic and diastolic pressures go down simultaneously, though not always the same number of millimeters. Occasionally the systolic goes down faster than the diastolic until the pulse pressure reaches 20. I then lessen the dose to 1,000 or 1,250 E., or skip a treatment or two, and if after this it remains at 20, or possible goes down to 18, I stop the treatment altogether, whether the systolic is down to normal or not, and usually give some sharp sparks to spine to raise the systolic, and thereby also the pulse pressure, until the latter is above 20.
    I have met with occasional cases in which no benefit or only a very temporary reduction followed the use of auto-condensation.
    Increased determination of blood to the surface of the body lowers the blood pressure and, conversely, driving the blood from the surface, raises it. Therefore, any remedy that increases peripheral circulation lowers the blood pressure. In addition to the drugs employed for this purpose may be mentioned electric light baths, oxygen baths, etc. In advanced cases care should be exercised not to reduce the blood pressure too rapidly at first.
    We must not lose sight of the fact that either auto-condensation or auto-conduction, if capable of lowering blood pressure, is equally capable of preventing the development of arteriosclerosis when employed at the first sign of increased pressure. In brief, the effects of old age may be discounted.
    I voice the view of many authorities when I state that a man past forty, who is under considerable strain or carrying a heavy load in his business or profession, and who finds difficulty at times in concentrating his attention, awakens in the morning more tired than when he went to bed; has occasional spells of dizziness or light-headedness, or notices occasional tingling or numbness in the extremities, owes it to himself to ascertain whether or not these symptoms are pointing toward the development of arteriosclerosis. If his fears prove groundless, well and good; but if evidences of arterial involvement are present, they will be discovered in time to prevent their untoward effects.
    Articular Rheumatism (See Rheumatism).
    Asthenopia. Use the body electrode carrying a spark of from one-fourth to three-fourths of an inch, according to the sensitiveness of the patient, and keep the tube at full sparking distance. Pass it rapidly up and down the spine for three minutes.
    This treatment is satisfactorily applied through some layers of clothing, as the latter insure a definite spark length. In women the corset would be removed if any steels are where they will be charged by the current. If a chain is worn around the neck it should be taken off.
    Follow the spinal treatment by an application of the same tube to the back of the head and neck for three minutes longer, then over the eyes for two or three minutes, keeping it in contact with the skin. Finally use the double eye tube, Fig. 6, for three minutes. Three to six treatments per week.
    Ozone inhalations and vibration are useful adjuncts.
    Asthma. The treatment of asthma may be by vacuum tube applications over the chest or by placing a diaphragm so that a powerful effleuve or fine sparks will fall upon the chest.
    The vacuum tube should be used with as sharp a spark as the patient will permit and is conveniently applied through the underclothing.
    Mechanical vibration is especially useful in connection with high frequency.
    Direct D'Arsonval application with one sponge to the back and the other moved back and forth over the chest is another method. Daily treatments of about ten minutes' duration. A cure should not be expected.
    Ataxia (See Locomotor Ataxia).
    Atonic Dilation of the Stomach. In this disease we have complete relaxation of the motor fibres of the stomach and the treatment must be that which will cause them to actually contract and regain their normal tone. The first cases treated by high frequency were those reported by Chisholm Williams. He employed the vacuum tube for five minutes locally over the stomach, followed by auto-condensation for ten minutes. This treatment was repeated daily. In one case a cure resulted in six weeks. This author also reported results in seventeen cases treated by Drs. Crobie and Bokenham. The results were proved by skiagraphs.
    One method that has been used in treating this disease has been to localize the effects of auto-condensation by using the metal electrode and placing a piece of plate glass between the electrode and the stomach area. The plate glass is the di-electric. The electrode corresponds to one layer of condenser, and the gastric area to the other, thus obtaining the effect of auto-condensation.
    I have found general auto-condensation treatments (2,500 to 7,500 E.) Were entirely satisfactory for this disease often combining with mechanical vibration. The sinusoidal current has proved of essentially equal value. While applying the general auto-condensation on the couch, it is possible to draw sparks from the body with the vacuum tube locally over the stomach at the same time with benefit. The foregoing treatment is equally effective in atony of the stomach when dilation is not present.
    Atrophic Rhinitis (See Ozena)
    Atrophy of the Optic Nerve. The method of treating this disease with high frequency currents has been by the use of the eye electrode, single or double, as required, the same being held in contact with the closed eyelid and the current allowed to pass for from five to ten minutes. The current is of a strength just short of producing painful sparks on the lid. In place of the eye electrode, I have used the form shown in fig. 21, No. 11, using a current that would not be capable of producing a spark of more than one-sixteenth of an inch, and keeping it in light contact with the lid while it is passed back and forth for several minutes. Another author suggests at the same time an application with a stronger current, keeping the tube in loose contact with the skin over the temple for about the same length of time. Daily treatments are advised.
    Baldness (See Alopecia).
    Barbers Itch (See Sycosis).
    Bladder Disease (See Cystitis).
    Bladder, Papilloma of. See Technique under fulguration, Chapter VI.
    Blepharitis. In a large number of cases of blepharitis a cure has resulted from the use of a very mild spark from the vacuum tube. Sometimes it has to be persisted in over a long period on account of a marked tendency to relapse. One case referred to me by Dr. Rager which had resisted all of the usual routine treatment improved rapidly under three applications a week of the high frequency current in connection with the high candle power light. Over sixty treatments were given, however, before the case was essentially cured. Fox treated 100 cases with no failures.
    The technique which I employ is as follows: I use the electrode shown in Fig 21, No. 11, with just enough current to produce a stinging sensation when applied to my own eyelid, the fine spark from it being from one-thirty-second to one-sixteenth of an inch length. I raise the upper lid by pressure with the thumb and apply this fine spark along the edge for two minutes, and then pull the lower lid down and do the same. Then while the patient closes the eye I pass the electrode over the whole surface of the lids for two or three minutes longer. A daily treatment is preferable, but three times a week will suffice.
    Blindness from Inter-Ocular Hemorrhage. In this condition the current is used to promote absorption, and as the blood pressure is always high, there is an indication for the use of auto-condensation or auto-conduction for the purpose of reducing it.
    I report a most interesting case which occurred in the wife of a Methodist clergyman. She became suddenly blind in the left eye and applied to me for treatment. Not being an oculist I referred her to Dr. Good for diagnosis, and he found on examination that a considerable hemorrhage had occurred, thus obstructing the vision. An unfavorable prognosis was given. I treated the case in the following manner: The patient's blood pressure was 156 and there were abundant signs of arteriosclerosis, so she was given first 2,500 Eberharts on the auto-condensation couch, after which the vacuum electrode (Fig. 21, No. 11) was rubbed gently over the closed eyelids, temple and supra-orbital region, using a mild current, capable of giving a slight stinging sensation when passing in loose contact with the skin, After this, very mild mechanical vibration was applied through my fingertips to the closed eye for thirty to sixty seconds only. Daily treatments were given and the result was little short of marvelous. Inside of two weeks the sight returned to the eye and a few weeks later it was stronger than before the hemorrhage occurred, as the patient had had some difficulty with this eye for many years.
    Blood Pressure. See Hypertension (High Blood Pressure), also Hypotension (Low Blood Pressure), and Arteriosclerosis.
    Brachial Neuritis. (See Neuritis.)
    Brain Fag. "Brain Fag" has come to represent a condition just one step removed from complete nervous prostration. It is common in business men, especially where too close attention to business has been accompanied by too little exercise. The favorite prescription has been a complete change of scene, such as a sea voyage. This treatment is not always possible, and much may be accomplished by the use of high frequency currents, ozone, and mechanical vibration.
    The nature of the high frequency treatments should be in accordance with the patient's blood pressure. If the blood pressure is high, auto-condensation or auto-conduction is clearly indicated, and 2,500 to 5,000 E. Should be applied daily, or even twice a day if the case is urgent. Following this, the vacuum tube with a spark just strong enough to have a good tonic effect should be applied to the forehead over the eyes and to the back of the head and neck. The patient will nearly always complain of pain in the back of the neck, the pain so common in neurasthenia.
    In many of these cases the blood pressure is below normal and in these the use of auto-condensation or auto-conduction is distinctly contra-indicated. Instead there should be the application of sharp sparks, say one-half inch or more in length, up and down the spine for four or five minutes, then over the abdominal region for three minutes more, finishing with the application over the eyes and back of the neck, as outlined above.
    In all cases, two or three minutes' inhalation of ozone after the high frequency treatment is desirable, or if possible the patient should install an ozone machine in his office and also in his sleeping room so that he is constantly breathing air charged with a large amount of ozone. (See Chapter IX.) When the blood pressure is low a mild stimulating application of mechanical vibration along the whole spine is indicated, dwelling somewhat longer over the back of the neck.
    Bronchial Asthma. (See Asthma.)
    Bronchitis. High frequency currents are useful in acute bronchitis but circumstances usually render them unavailable. If, however, the physician has a portable high frequency outfit and there is electricity in the patient's room, he will find that a reasonable sharp spark over the chest and back, until they are well reddened, will give relief. This treatment may be repeated every hour until a sufficient moderation of congestion is obtained.
    An ozone generator should be placed in the room to ozonize the air. This is really more important than the high frequency application.
    In chronic bronchitis the vacuum tube may be used over the chest and back, as in the acute form.
    At the present time in connection with the vacuum tube application general auto-condensation is employed (2,500 E.) or it may be applied locally according to the "Plate-glass method" described in Chapter VI: Here ozone is again clearly indicated, the preferable method being ozonization of the air in the room where the patient sleeps or works; this being superior to the temporary administration of ozone in the physician's office. Treatments should be given daily at first, gradually dropping to two ro three times a week.
    Callouses. Callosities of all kinds, including corns, are treated by the application of sharp high frequency sparks; either from glass or metal electrodes or by means of the regular fulguration point. Caustic fulguration is preferable.
    Cancer. (See Carcinoma.)
    Canities. (See Gray Hair.)
    Carbuncle. In treating carbuncle the high frequency currents are used as an adjunct to the X-ray, although they have proved effective when used alone. Enough current should be sent through the tube to produce a one-fourth to three-fourths inch spark and the tube should be kept in loose contact with the inflamed area and passed back and forth over it for ten or fifteen minutes. This should make an appreciable difference in the pain and promote an early ripening of the carbuncle.
    In cases where suppuration has already occurred the progress of the case may be hastened by the same technique.
    Carcinoma. (Cancer). The best treatment for cancer is the use of the X-ray in connection with surgery, but in many instances benefit is obtained from the local use of high frequency sparks. The present method of utilizing these sparks is by means of caustic fulguration. (See Chapter VI.) Anaesthesia may be necessary.
    In Fig. 53 is shown a case of cancer treated by Dr. Carreras by fulguration, a small portable coil being employed. The middle picture was taken three weeks after commencing treatment and the right hand picture in another three weeks.
 

    Cataract. In the early stages of cataract benefit may be expected from the high frequency current in a reasonable percentage of cases.
    It is applied according to the eye technique given in Chapter VII. Five minute daily treatments with not too great an intensity of current; tube in contact with closed lids.
    Catarrh of Bladder. (See Cystitis.)
    Catarrh of Bowels. (See Colitis and Enteritis.)
    Catarrh of Nose. (See Nasal Catarrh; also Ozena.)
    Catarrh of Womb. (See Endometritis; also Cervicitis.)
    Cellulitis. The red vacuum is preferable in treating cellulitis. After freely incising the parts to establish drainage, apply wet dressings and then use the high frequency current through the dressings, five to seven minutes, repeating frequently.
    Occasionally in an early stage the application of the high frequency in connection with a high candle power light may arrest the progress of the trouble; but if it does not do so quickly, the above method is advised.
    In this instance the current is merely an adjunct to our usual methods.
    Cerebral Hemorrhage. Dr. L. M. Bowes, who has had a wide experience in these cases, states:
    The prophylaxis consists in treating the underlying cause-arteriosclerosis, nephritis, chronic alcoholism or syphilis-which is describe under the proper heading.
    When there are prodromal indications of hemorrhage-headaches or dizziness, in one whose arteries are liable to rupture-the patient should be placed in bed with the head raised and feet lowered. If there is hypertension, auto-condensation or auto-conduction is indicated.
    Give a brisk purgative followed by an enema. During the attack the patient should be kept absolutely in the position given above, with an ice-cap on the head and heat applied to the extremities. Hot baths should be absolutely forbidden.
    The absorption of the extravasated blood is promoted by the use of auto-condensation or auto-conduction, combined with the use of small doses of the iodides.
    For the paralysis the treatment should be the same as outlined under the heading of paralysis, remembering that only the weak muscles should be treated. If the strong muscles are treated the contractions are liable to be increased.
    Cervical Adenitis. (See Tuberculosis of Glands).
    Cervicitis. In inflammation of the neck of the womb, with or without hyperplasia, the use of the high frequency current through the vagina is very effective.
    The insulated vaginal tube is employed and care is taken to be sure that it is in contact with the cervix. Seven minute treatments, daily or every other day, using a current strength that would be capable of producing a one-half or three-fourths inch spark if the tube were not in contact with the body.
    A small tube, such as the nasal tube, may be inserted in the neck of the womb in cases accompanied by relaxation where the mouth of the uterus is open. This tube must not come in contact with a metal speculum or it will charge it with the current. It must be insulated with rubber or sufficient dry gauze. A glass speculum of the old-fashioned tubular type is preferable. The direct D'Arsonval current (diathermy), is also useful in this disease. (See Chapter XI.)
    Where the cervix is considerably enlarged mechanical vibration is advised. I have devised a uterine vibratode which is very convenient and serviceable in treating these cases, because the vibrations may be limited to the desired area. It consists of a flexible uterine sound with a section of rubber tubing between it and the attachment to the vibrator to prevent undue force being used, and application is made directly to the cervix through an ordinary speculum.
    Chancroid may be treated with the spark from the vacuum tube or by caustic fulguration. One treatment should suffice and is superior to acid cauterization. Take care not to apply too long. One-half to one minute is usually sufficient. Sometimes I place the vacuum tube over the chancroid with two or three layers of gauze between, thus utilizing short but rather thick sparks. In this instance keep in contact for five minutes and repeat in eight to twelve hours.
    Where a soft chancre exists just within the meatus, treatment by means of the end of an urethral electrode is extremely satisfactory for apparent reasons. Treat for seven minutes and repeat twice a day in the start.
    Chilblains. Use a vacuum tube with a current strength capable of producing a quarter or half inch spark, but keep the electrode in contact with the skin. It may be held steadily over the chilblain or moved slowly about as desired. Treat for ten minutes or until relief is manifest and repeat daily or very other day until cured.
    In connection the soaking of the foot in a strong solution of acctate of zinc (tablespoonful to the quart) is advised.
    If a porcelain bowl is used the high frequency electrode may be placed in the solution after the manner of using the faradic current.
    Chloasma. (See Moles, Moth-patches, etc.)
    Chlorosis. (See Anemia and Chlorosis.)
    Chorea. In chorea general treatment with a sharp stimulating spark to the spine, abdomen and extremities, taking about 15 minutes for the treatment and repeating daily or every other day, is advised.
    Auto-condensation alone, or in connection with the foregoing, is indicated; also mechanical vibration and ozone.
    Chronic Ulcers. Use at first a sharp spark from the vacuum tube to get a stimulating effect, which is not only locally germicidal, but also converts the chronic condition into an acute one which will heal readily. Afterwards treat through two or three layers of gauze, with a tube in contact, capable of giving a quarter-inch spark.
    Fulguration, with mild spark may be employed.
    Cicatrices. (See Scars.)
    Cold Extremities. I have included this symptom because it is so common and because the high frequency is really an ideal treatment for the condition.
    Vacuum tube applications to the extremities to the production of redness give an immediate result.
    In order that it may have a permanent effect, a tonic dose along the spine and over the abdomen is advised; the treatments to be repeated three times a week.
    Diathermy is also indicated. (See Chapter XI.)
    Colitis. (Inflammation of colon, mucous colitis.) This is a condition which has not yielded to ordinary methods, but which has proved singularly amenable to the high frequency current.
    Several methods of employing it have been almost equally effectual. They are:
    1. The vacuum tube with a current intensity capable of emitting a half or three-quarter inch spark may be passed lightly over the bowel areas, either in contact with the skin or through the underclothing. Duration, fifteen minutes. Repeat daily until improvement takes place, and then continue three times a week until cured.
    2. The Tesla current or the direct D'Arsonval (diathermy) applied with one electrode over the bowel and the other in the rectum.
    3. Auto-condensation, either general or local or by the "Plate-glass" method. (See Chapter VI.)
    Ten or fifteen minute treatments daily or every other day.
    Auto-condensation may be combined with any of the other forms. It is my preference-3,500 E. daily.
    Constipation. I believe mechanical vibration and the sinusoidal current are superior to high frequency in these cases, but the latter may be used advantageously.
    A vacuum tube application over the abdomen is indicated. The lower the frequency the more effective the treatment.
    For this reason treatment with the small Tesla coils is especially satisfactory; also the use of pulsatory currents, (tube attached to one pole of X-ray coil).
    Considerable current should be passing through the tube, averaging an intensity capable of delivering a spark of from one-half to one inch, but taking care to keep the electrode in close contact with the abdomen and thereby avoid any sparking.
    Ten minutes daily is advised first, later dropping to two or three times a week.
    Another method is to use the Tesla current or the direct D'Arsonval (diathermy) with one electrode on the abdomen (stationary or moved about), and the other in the rectum. Local auto-condensation commends itself and the author's D'Arsonval surgings given with a pad or metal electrode over abdomen, will give motor effects.
    Convalescence. In convalescence the general tonic effect of auto-condensation 2500 E., or a mildly stimulating vacuum tube spark to the whole body, will aid the patient in regaining strength.
    Corneal Opacity. Applications are made with the eye tube through the closed lids or may be made directly to the cornea, taking care to have perfect electrical contact. Three to ten minutes at a treatment, frequently repeated.
    Corns. (See Callouses.)
    Coryza. For cold in the head a low vacuum tube carrying enough current to produce a half inch spark is rubbed over the outside of the nose, along the supra-orbital region, and the sides of the face.
    Ozone is inhaled directly from contact with the tube or by means of an inhaler.
    Intra-nasal application with the nasal electrode (See Figs. 20 and 21) is also advised.
    Two or three treatments a day may be employed if necessary.
    Cystitis. The effect of vacuum tube treatment through the rectum or urethra is remarkable in inflammation of the bladder.
    In one case where many clots of blood were passing with the urine, and had been doing so for some days, it was greatly lessened after the first treatment and entirely disappeared after the second. The urethra was too sensitive to admit the sound and the treatment was administered per rectum.
    The technique for urethral or rectal applications will be found in chapter VII.
    A seven minute treatment is given daily at first and then every other day. Two treatments a day may be employed if the physician thinks best. It is remarkable how fast the urine clears up in nearly all of these cases.
    In acute cases I always use the rectal technique but in old chronic cases I alternate with the urethral method. In women the vaginal technique is used.
    Local treatment over the bladder with the body tube is also beneficial, or diathermic currents with electrode in rectum and pad over bladder. A bi-polar Tesla treatment may be given in the same manner.
    Dandruff. (See Seborrhea.)
    Deafness. In catarrhal deafness the high frequency current in connection with mechanical vibration will yield remarkable results in ninety per cent of the cases treated. Not that it may be expected to cure so large a percent; but the degree of improvement will be so marked that both physician and patient will be well satisfied. The ear tube is used as outlined under ear technique in chapter VII, the duration of the treatment being from two to seven minutes according to the toleration of the patient. The current must not be too sharp.
    The sensation of heat will become so marked that the patient will tell you when to stop. If he does not, do not carry the seance beyond seven minutes, for either ear.
    Two treatments a day are not too many in the start, but this is seldom practicable and we must content ourselves with from three to six per week.
    Diabetes. In the earlier use of high frequency currents we were confronted by a variety of reports regarding the effectiveness of this treatment in diabetes, but even those who gave adverse opinions concerning the disappearance of sugar, admitted that there was improvement in the patient's "sense of well-being."
    I am willing to put myself squarely on record as believing auto-condensation to be the best single remedy we have for diabetes, and best of all it does not prevent us from using at the same time all of the other measures which experience has shown us to be valuable.
    In my first cases I used auto-condensation without altering patient's diet, or prescribing any internal treatment in order to determine exactly how much reliance might be placed on this method. All specimens of urine were sent to a reputable laboratory for examination so that no personal wish might influence my judgment of results.
    In one of these cases the sugar and all accompanying symptoms disappeared in the incredible time of six weeks. (There was six per cent of sugar in the beginning). Three to six months has been more nearly the average time required. The sugar has not disappeared in every case, but in no case has there not been a perceptible decrease in amount and a general improvement where the treatment lasted over two months.
    One case died in four weeks, only ten treatments being given. The acetone increased and I predicted death within two weeks. A sudden and decided increase in acetone or its appearance when none has been present, I regard as an unfavorable sign usually indicating a fatal termination within two or three weeks.
    One of my worst cases where the patient could scarcely get to the office for treatment made such a steady improvement that in five months the sugar had dropped from seven and a half per cent to one and three-tenths per cent, he had resumed work and was gaining rapidly in weight, and I was absolutely sure a complete cure would result, when he died suddenly. The cause was apparently the result of an excess in drinking (which had been forbidden), raising the blood pressure to the point of rupturing one of the arteries in the brain.
    Treatments should be given daily at first, starting with 2500 E., and if improvement is not manifest within a week increasing to twice that amount or even more. The only exception is where there is an advanced case of arteriosclerosis with marked hypertrophy of the heart muscle, when the blood pressure should not be diminished too rapidly.
    When improvement is pronounced, decrease the dose and treat three times a week.
    In examining the urine the total amount for twenty-four hours must be collected and measured and a specimen from this examined; otherwise a test for the percentage of sugar will be valueless, for if half a dozen separate specimens are examined in a day, there will be given an equal variety of percentages.
    As diabetes is apparently a disease resulting from disturbed or impaired metabolism it is entirely reasonable to expect benefit from the administration of auto-condensation.
    I do not enforce a rigid diet, but a regulated one.
    Other operators have employed in place of the auto-condensation a vacuum tube spark over the abdominal area. Many find the X-ray of decided value, exposing over the liver.
    Diarrhea. One author says, "After preliminary treatment of the canal or being assured that no foreign matter remains in it, apply tonic dosage of high frequency current over the region of the solar plexus, stomach, intestines, liver and spinal nerves." I note that he advises essentially the same method for constipation.
    As few cases of diarrhea come under the treatment of the electro-therapist I am not able to give a definite opinion, but would think a prolonged but soothing treatment over the abdominal organs preferable. Inhibitive vibration I know to be effective and would advise it in conjunction.
    Drug Addictions. In drug habits I have found more benefit from vibration than from high frequency currents, but the latter may be used conjointly. In alcoholism, a sharp stimulating spark over liver, solar plexus and fifth to ninth dorsal spinal centers is advised; also auto-condensation, 2500 E. repeated three to six times per week, provided blood-pressure is high. (It is usually.)
    In the cocaine habit use mild vacuum tube treatment to soles of feet; and to arms and legs to the point of marked reddening. If blood-pressure is low use stimulating sparks to the spine; if high give auto-condensation. In morphine or opium users give sharp stimulating spark over liver and solar plexus, with auto-condensation or spinal sparks according to whether the blood-pressure is high or low.
    In all of these habits treat insomnia, constipation or other accompanying symptoms as advised under those headings.
    Drupuytren's Contraction. For the contraction of the fascia in the palm of the hand known under this name, high frequency currents have been successfully used by Herdman.
    Auto-conduction or auto-condensation, 2500 E. Three to six times per week with vacuum tube sparks locally for five minutes. Mechanical vibration indicated.
    Dyspepsia. The technique to be followed is essentially that outlined under atonic dilatation of the stomach. The best teatment is auto-condensation, 2500 to 5000 E. daily. It may be employed locally by the "plate-glass" method (See Chapter VI), thus making it possible to utilize the small coils for this purpose. D'Arsonval surgings (see Chapter VI) are of equal value.
    Vacuum tube applications over stomach and solar plexus are advised if auto-condensation is not available. The general tonic effect of ozone inhalations or of ozoning the air of room or office, makes it a usual adjunct.
    Earache. This symptom is frequently relieved by the application of the ear tube using a mild current for from three to seven minutes, the benefit being apparently due to the heat evolved.
    Another method has been the use of a flat electrode over the mastoid.
    Ear Diseases. The principal diseases of the ear which are benefitted by high frequency currents are: catarrhal deafness, tinnitus aurium, and chronic middle ear affections. The method of treating each of these is given under its appropriate heading.
    Eczema. In the treatment of eczema the high frequency is an invaluable adjunct to the X-ray, but may be used independently of it with successful results. This disease reacts to the X-ray very quickly so that care must be used in the number and length of exposures. The high frequency is applied according to the technique described in Chapter VI, under skin diseases, where the body tube or the tube shown in Fig 21, No. 11, is used with a sufficient amount of current to produce a spark from one-fourth to three-fourths of an inch in length, but during the greater part of the treatment it is kept in light contact with the surface, or the treatment is applied through a layer of gauze.
    Where there is intense itching it is found that raising the tube to produce a moderately sharp spark proves quickly effective and is very agreeable to the patient. As with the X-ray we must be careful and not treat the case too long at one sitting. From two or three to eight minutes daily or three times a week is advised; the shorter treatments should be given when used in connection with the X-ray. One of the high frequency X-ray tubes made to hold and apply to the surface in a manner similar to that of the ordinary vacuum tube would undoubtedly be especially satisfactory in these cases. An ozone spray (see Chapter IX) is recommended when available.
    Enlarged Prostate. (See Prostatic Diseases.)
    Endometritis. Treat same as cervicitis.
    Enteritis. In enteritis of a chronic character high frequency currents may be expected to benefit in the same way that they benefit all catarrhal conditions. In acute forms there is a question whether the current is of sufficient value to warrant its employment when there are so many other agencies of equal or greater effectiveness that are more easily resorted to.
    The treatment advised would be tonic applications over the abdomen with the vacuum tube and a mild spark; or local auto-condensation, three to six treatments pre week, of ten minutes each.
    Epididymitis. In acute forms a vacuum electrode applied with mild current and held in contact with the area involved or the use of diathermy is advised. In either case a ten-minute application repeated in two or three hours until relief is obtained. In the chronic form the same method is employed. The treatments are then given daily or three times a week.
    The X-ray is very effective in these cases, but on account of its tendency to produce sterility, it is sometimes objected to. The surrounding parts should be protected by a lead shield or the treatment may be applied through one of the narrow tubes or speculums connected with a tube shield.
    In my experience where there has been any considerable inflammation of the epididymis, that side is already inactive, and there is no special reason to hesitate about using the X-ray.
    Epilepsy. The high frequency current in connection with the X-ray has been used in treating epilepsy with a number of apparent cures according to several authors. The method employed is the use of a medium or high vacuum X-ray tube, placed at ten inches and used for five or ten minutes, followed by vacuum tube application over the brain, and along the spine for five minutes longer. Treatment is repeated three times a week.
    It is questionable in my mind whether there is sufficient benefit in these cases to warrant the use of the high frequency current.
    Epithelioma. In skin cancer our best non-operative treatment is the X-ray, whether generated by high frequency apparatus or with the ordinary machine. The high frequency in the form of fulguration is also effective in the great majority of cases. Even the use of a very sharp spark, say three-fourths of an inch in length from a vacuum tube, has proved successful.
    Where the X-ray is used it has been my custom to give three exposures per week, of from seven to twelve minutes, with a low or medium tube followed by two or three minutes' application of as sharp a spark from the vacuum tube as the patient would tolerate.
    We also have in carbon dioxide snow an excellent remedy for these cases. After the glands have become involved the chance of cure by any method is greatly lessened.
    Erosions of the Cervix Uteri. These are treated with the vaginal tube, the insulated form being used, according to the vaginal technique described in Chapter VII, taking care to bring the tube in contact with the cervix. The treatment should last for seven minutes and may be repeated daily or every other day, as desired. Diathermy has been used in these cases, the patient holding a metal electrode connected to the other pole. No treatment should be given during menstruation.
    Exophthalmic Goitre. (See Goitre.)
    Eye Diseases. The specialist will find the high frequency current a very valuable adjunct to his armamentarium. Fox, in 1907, reported one hundred cases of blepharitis marginalis treated without a single failure. My own experience in this disease dating back to 1902 will bear this out. Iritis, retinitis, atrophy of optic nerve, conjunctivitis, trachoma, glaucoma, incipient cataract, paralysis of ocular muscles, intro-ocular hemorrhage have all been treated by high frequency currents. The special technique for each of these diseases is given under the appropriate heading.
    Favus. This condition which yields so nicely to the X-ray is also amenable to treatment by high frequency. A spark is employed as sharp as the patient will tolerate for from three to five minutes, three times a week.
    Fissure (Anal). So many reports of successful results in anal fissure have been made that there seems to be no doubt of its efficacy. It has always been my opinion that as much benefit was derived from the stretching of the parts as from the healing effect of the current. The rectal vacuum tube is employed as directed in Chapter VII and a seven minute treatment is given from three to six times per week.
    Flabby Breasts. It is claimed by Monell that a stimulating application with the vacuum tube to the relaxed nipple of the flabby breast will immediately show its beneficial effect.
    Frontal Sinusitis. (See Sinusitis.)
    Furunculosis. In treating boils a mild spark from the vacuum tube is employed over the affected area for ten or fifteen minutes. The treatment may be repeated two or three times a day if operator finds it advisable. It is well to cover a reasonable area surrounding the boil in order to prevent recurrences, if the boil is discharging. Another method is to use the fulguration point with a sharp spark for a few seconds. This frequently aborts a boil if employed in the early stages. Operators using the Tesla coil have told me that they obtain better results when the patient is directly attached to one pole of the machine and the grounded vacuum tube or metal point held within a short distance of the surface treated, thus drawing the sparks from the skin (indirect sparks).
    Open boils heal readily under an application of the ozone spray.
    Gastritis. In chronic gastritis the high frequency treatment indicated is local or general auto-condensation, or the methods may be followed which are given under atonic dilation of the stomach.
    Genito-urinary Diseases. The genito-urinary diseases in which these currents have proved useful include gonorrhea, gleet, prostatitis, cystitis, orchitis, stricture, etc. The directions for treatment will be found under these various headings.
    Glaucoma. As this condition is usually associated with high blood pressure as well as hypertension in the eye-ball, the use of auto-condensation 2500 to 7500 E. daily to reduce blood pressure naturally suggests itself and it was for this reason that I first employed high frequency currents.
    In conjunction with auto-condensation, I use the eye tube applied to the closed eye for five to eight minutes, when a very mild spark is employed over the eye-lid, eye-brow and temple with any flat surfaced vacuum electrode.
    I do not find any record of this condition having been previously treated by anyone else. There is, of course, no reason to omit any of the customary remedies used in these cases. The benefit is noticed frequently after a single treatment.
    Gleet. There are two methods that I have found equally satisfactory in the treatment of chronic posterior urethritis. The first is by employment of the urethral tube with the technique given in Chapter VII, taking care in the introduction of the glass sound not to break it and seldom extending the treatment over seven minutes at any one seance. The treatments may be given daily or every other day.
    The second method is to treat through the rectum with the rectal or prostatic tube, which I have found quite as effective, and much easier to employ and devoid of any danger from breaking of the tube. I have treated a large number of these cases, beginning as far back as 1902. The early cases were treated in conjunction with the X-ray, but on account of the risk in using the latter, I have abandoned it of late years and find high frequency currents even more effective.
    Cases are cured frequently in from ten to twenty treatments; occasionally it has taken more than twice the latter number.
    Goitre. In simple goitre the high frequency current is applied with the vacuum tube, using an intensity capable of producing a half or three-quarter-inch spark.
    The tube should be kept in light contact with the surface of the skin, treating the sides of the neck as well as over the goitre itself. After five minutes of this treatment, raise the tube and use as sharp a spark as the patient will permit for two or three minutes.
    The X-ray is used always in connection with the high frequency and mechanical vibration also. About one-half of the cases are cured.
    In exophthalmic goitre the results are much better than in simple goitre.
    The vacuum tube is employed in the same manner followed by auto-condensation, 2500 E. X-ray and vibration recommended.
    Gonorrhea. In acute gonorrhea in the male the current is markedly beneficial. If the canal is not too sensitive the urethral vacuum tube may be used, but this is seldom possible.
    A method is to use a glass tube containing boric acid solution and having a metal bottom to which the connecting cord is attached.
    A daily treatment should be given and I have not hesitated to give as many as three in one day in some instances.
    In the female the vaginal tube is used or the vagina may be packed with moist gauze and a metallic electrode attached to the gauze.
    Usual methods of treatment may be carried out in connection with the high frequency.
    In sub-acute or chronic forms the vacuum tube method is preferable in either sex. In men, treatment through the rectum is effective.
    The precise action of high frequency in these cases is still in doubt. It may be the germicidal effect of the ozone liberated, or the increased leucocytosis established. With tubes of high vacuum the chemical rays emitted are entitled to credit.
    Gout. Auto-condensation or auto-conduction is the high frequency treatment for gout, as in all diseases resulting from disturbed metabolism. The urine is found to have immediately an increased amount of urea, while the excessive uric acid rapidly decreases to normal.
    2500 to 7500 E. daily or three times a week is a proper dosage. A slight aggravation of pain may be present after the first few treatments, for which reason I sometimes start with a smaller dose and gradually increase.
    No treatments should be given during an acute attack. Arc light or electric light baths are beneficial in any stage.
    Where the vacuum tube is applied in these cases, it should be kept in close contact with the skin, avoiding all sparking. Indirect spark during auto-condensation is very beneficial.
    Gray Hair. I discovered, accidentally, the action which these currents have in restoring the natural color to gray hair. This apparently is not limited to premature grayness.
    The chief drawback to the treatment is that it may have to be kept up for months and months.
    Vibration of the scalp to aid in increasing nutrition is desirable. The high frequency treatment consists in vacuum tube applications.
    From my original article on this subject, published in the American Journal of Clinical Medicine, November, 1909, I quote some paragraphs:

    "As early as 1902 I began using high frequency currents usually in connection with vibration, in the treatment of various conditions of the scalp where the hair was thin or falling out rapidly.
    "Vibration was employed because of its stimulating effects on the circulation, and high frequency sparks because of this same beneficial influence on the nourishment of the hair roots, and further on account of its germ-destroying action where bacteria were responsible for the falling hair.
    "The possibility that high frequency currents might be useful in restoring the original color to gray hair did not occur to me, and had it done so I should have thought it impossible in consequence of the fact that these currents have been used commercially in bleaching flour and other substances.
    "My first discovery of the 'restorative' effect on gray hair came about in an accidental manner.
    "I was treating a woman whose hair was falling out very rapidly, employing both high frequency current and vibration. Her hair was very black but sprinkled over her head were three or four dozen gray hairs which were especially conspicuous by contrast. She asked me if it would do any harm to pull out the white hairs, and I told here that as long as she was losing so much hair, anyway, she might as well pull out the objectionable gray ones.
    "After about two months of treatment the hair had practically ceased falling out and I noticed that there were scarcely any gray hairs. I thought she had been pulling them out and said so. When she replied that she had been afraid to do this despite my permission, I said to her that the treatment must be restoring the color and proceeded to investigate. The finding of a few hairs white at the upper end and dark for a varying distance next the scalp convinced me absolutely that my surmise was correct. From that time on I have employed high frequency currents in all of these cases that have come under my care.
    "For a long time I believed that only in prematurely gray hair any improvement could be expected, but a recent case makes me think that if patient and physician are sufficiently persevering, results may be obtained in many instances where the gray hair is the natural result of advancing years.
    "The case referred to is one in which I have for somewhat over a year and a half been treating a very stubborn case of lupus, situated behind the left ear. The patient, a man in the fifties, has gray hair which can scarcely be called premature.
    "The treatment for several months consisted in an application of high frequency sparks six days a week, preceded every other day by exposure to the X-rays; and even now that the patient is nearly cured he is still receiving two such treatments a week.
    "Recently I noticed that around the ear where I had been applying the sparks there was a band of dark-brown hair about an inch in width. I thought possibly this was so all around the margin of the hair, but found it did not exist except over the area receiving the high frequency sparks, and a reference to the picture of the man taken when treatment was begun shows that at that time where was no apparent difference in the shade of the hair at this point.
    "All of this brings me to the conclusion that gray hair must be entirely a result of disturbed nutrition, preventing the carrying into the hair of the pigment that gives it its color. This pigment-carrying property, in all probability, depends largely upon the natural electrical currents which traverse various tissues and which when interfered with in the hair result in grayness.
    "Laying aside theory, results tell, and it is easy for anyone to prove the truth of my statements. The only drawback is the comparatively long time required. Some cases show results in two or three months, but six months is nearer the average.
    "In the case of naturally gray hair I fear few patients could be kept under treatment long enough, since in the instance cited, a year and a half elapsed before the change was noticed.
    "The method which I have employed is first to use a rubber brush or soft rubber vacuum cup on a vibrator and for three or four minutes thoroughly massage the scalp, stroking from the edge of the scalp inward toward the center of the crown of the head, or else using short circular strokes and gradually passing from the margin to the center. Following this, a glass vacuum tube is employed and passed rapidly back and forth over the scalp for five minutes, with as sharp a spark as the patient can conveniently tolerate. This is usually one about one-half or three-fourths of an inch in length. Too sharp a spark might make the scalp sore and even have a slight caustic effect, which is to be avoided.
    "Daily treatments are the best. I employ a similar technique in falling hair. Keeping the tube in loose contact with the scalp is equally effective."

    Grippe. (Influenza.) In connection with the usual medicinal treatment great benefit will be derived from the general application of the high frequency current and the inhalation of ozone.
    Ozone is particularly valuable in these cases, especially where the patient can have an ozonizer in the room.
    Otherwise inhalations by means of any of the several generators, or in default of one, the vacuum tube held with the hand in contact with the vacuum will give a sufficient amount if brought near the nose.
    The general treatment is by tonic spark to spine and solar plexus; also mild treatment over eyes and sides of nose. (Intra-nasal with special tube is advised in certain cases.)
    Hair, Falling. The vacuum tube applied as described under scalp technique in Chapter VII, especially in conjunction with vibration, is very effective where the hair is falling out. (See Alopecia.)
    Hay Fever. (Periodic Hyperesthetic Rhinitis.) Many reports have been made of the favorable influence of high frequency in these cases. Direct applications to the nose with the nasal vacuum tube and mild current, also using any suitable tube to stroke over the nose externally, as in nasal catarrh, is the customary technique with tonic spinal treatment of auto-condensation as indicated.
    Inhalations of ozone are of even greater importance or still better ozonizing the air of the room. The patient should be examined for enlarged turbinates or nasal polypi and if found they should be removed.
    The hyperesthetic areas in the mucous membrane should be destroyed. Fulguration sparks may be used for this purpose, although I see no advantage over customary measures.
    Headaches. Frontal or congestive headaches are relieved by using the vacuum tube with an intensity capable of producing a half or three-quarter inch spark and by passing the tube back and forth over the seat of pain.
 

    Keep the tube in loose contact and prolong the treatment until relief takes place, which will be five, eight or occasionally ten minutes.
    Inhibitive vibration in connection is advised, being fully as effective as high frequency.
    Only temporary relief may be expected in toxic headaches or in reflex headaches from organic diseases unless the underlying cause is ascertained and treated.
    In Fig. 54, taken from my "Vibratory Technique," the areas where headaches occur are outlined. This will be useful in suggesting the probable line of treatment.
    Headaches as A or B are congestive or frontal. At A they may come from errors in refraction; frontal sinus disease or nasal disease. Stomach diseases also frequently cause pain at A. Constipation A-B. Decay of front teeth A-B. Anemia; endometritis; bladder disease, C. Middle ear disease; throat disease; eye disease; decayed teeth, D-E. Womb disease; spinal irritation; nervousness, E. Ovarian reflex pains usually at C and E. Neurasthenic headaches involve the back of the neck.
    Heart Disease. One author says; "Tesla currents are often of great value in organic heart disease in assisting nature to establish compensation. In later stages when compensation fails the current is palliative through its action on the vaso-motor system and its tendency to disperse dropsical effusion."
    Treatments are given according to the indications shown by the patient's blood pressure. If the latter is high auto-condensation is called for; if low sparks to the spine and solar plexus.
    Hemorrhoids. Outside of the use of fulguration for the removal of hemorrhoids, I am not impressed with the value of high frequency currents in these cases, despite a number of favorable reports. Of course they are palliative and relief may result from their treatment with the rectal electrode as directed in Chapter VII, under Rectal Technique.
    For well-marked cases my advice is operation. Whether they are removed by the knife or scissors, or whether by the electro-cautery, or by fulguration sparks, is a matter for individual choice.
    Local anesthesia will suffice for fulguration in these cases and the spark need not be a very long nor sharp one. More than one application may be necessary.
    Herpes Zoster. (Shingles.) Application of the vacuum tube discharge to the eruption in herpes is almost uniformly serviceable in hastening a cure.
    The tube should be capable of delivering a quarter, half or three-quarter inch spark, but should be used in loose contact with the surface or through a layer or two of gauze. Treatment should be applied to the nerves supplying the area. Repeat the application daily as long as required. Two to four treatments ordinarily are sufficient.
    Mechanical vibration advised and ozone inhalations for their tonic effect.
    High Blood Pressure. (See Hypertension.)
    Hyperesthetic Rhinitis. (See Hay Fever.)
    Hypertension. (High Blood Pressure.) This symptom is the most common one accompanying arteriosclerosis, and the technique of treatment is given under that heading.
    The technique of taking the blood pressure is described in Chapter VI.
    High blood pressure always calls for auto-condensation, or auto-conduction. It also contra-indicates the application of sharp stimulating sparks to the spine, as these tend to raise it still more.
    Hypotension. (Low Blood Pressure.) In this condition we have the opposite to the preceding heading, and the treatment indicated is sharp stimulating sparks to the spine and solar plexus, while auto-conduction or auto-condensation is theoretically contra-indicated, although with low pressure it does not seem necessarily to lower it, depending on the pulse pressure (See Chapter VI).
 

    Hysteria. Many operators have reported successful results in hysteria. Auto-condensation should be used if blood pressure is normal or above.
    If the pressure is below normal, as is often the case, sharp vacuum tube sparks to spine and abdomen are advised.
    Impetigo. Treat according to the technique given for acne vulgaris.
    Impotence. The method of treating this condition is by means of the vacuum electrode. Use the body or prostatic tube with enough current to produce a spark one-quarter or one-half inch long or more.
    Keep the tube in loose contact with the surface while it is passed back and forth over genitals, inguinal and bladder region and to the lower half of the spine.
    With the spinal application raise the electrode to get reasonably stimulating sparks.
    Sometimes a special electrode is used which takes in the genitals, or they may be immersed in boric acid solution or water in a glass or porcelain vessel, and one pole of the D'Arsonval current (diathermic) in contact with the fluid, while the other electrode is in the patient's hand or applied to his back. Ten minute treatments daily. Rectal applications for seven minutes are often beneficial.
    Incontinence of Urine. (Enuresis.) Apply a tonic spark to the lower part of the spine and also over the bladder area.
    In selected cases treatment through the rectum to influence the neck of the bladder is desirable, and were it not for the fact that these cases occur in children the methods outlined under cystitis would be indicated.
    Infantile Paralysis. (Anterior Poliomyelitis.) These cases call for the daily application of stimulating sparks to spine and over all of the paralyzed muscles. Use a spark one-fourth or one-half an inch in length, with body tube.
    Interrupted galvanism and vibration are of equal value and should not be omitted. The tonic effect of auto-condensation makes it desirable.
    D'Arsonval surgings (See chapter VI), with the connection made directly to the ankles when the legs are affected, is of marked benefit because of the muscular contractions produced.
    Influenza. (See Grippe.)
    Insomnia. (Sleeplessness.) There are few cases of insomnia that cannot be cured by high frequency currents.
    The technique which I have found to be most satisfactory has been the use of a vacuum tube with sufficient current to produce a quarter or half-inch spark, which is kept in light contact with the back of the head and neck for about five minutes, followed by three or four minutes' application over the eyebrows.
    After this auto-condensation, 2500 to 7500 E. I always use vibration in connection with high frequency and ozone is indicated.
    Patients often fall asleep while taking auto-condensation; in fact, when using this method for other conditions you will often find your patients asking what it is that makes them so sleepy.
    I have cured so many aggravated and severe cases of insomnia with these measures that I am inclined to believe there should be no failures.
    One of the worst cases I have encountered was that of a man who found it necessary, on account of the sudden death of his brother, to work night after night until two or three o'clock in the morning in order to get through with his business. This and the shock of his brother's death (he was killed by a car) caused such a state of mind and body that when it became possible for him to take plenty of time to sleep it was found that sleep was impossible.
    At the time I undertook his treatment all of the customary measures had been exhausted and powerful narcotics only gave a transient respite; in short, grave fears for the man's mind were entertained.
 

I refused to take the case unless the patient agreed to take daily treatments for six weeks. It was within three or four days of the end of this time before any improvement was manifested, but the second course of treatments, covering the same length of time, entirely cured him.
    Intestinal Indigestion. With imperfect intestinal digestion we have indican present in the urine.
    Auto-condensation, either general or local, will cure these cases. The technique outlined under atonic dilatation of the stomach is equally useful here. The sinusoidal current also has cured many cases.
    The administration of suitable drugs does not conflict in the least with the electrical treatment. The diet should be regulated carefully.
    Intra-ocular Hemorrhages. The high frequency current is applied through the eye electrode in contact with the closed lid for five minutes.
    The blood pressure is always high in these cases and calls for auto-condensation, 2,500 to 7,500 E. Daily treatments.
    Iritis. Treat as outlined under eye technique, Chapter VII. The current relieves the pain and reduces the inflammation.
    In syphilitic iritis I have had especially satisfactory results in breaking up the adhesions which had formed.
    Keloid. Keloid may be destroyed by sharp sparks from the vacuum tube or caustic fulguration. The X-ray should be used in connection with high frequency.
    Drs. Frater and Frater, Shreveport, La., have reported remarkable results in one severe case.
    Laryngitis. In the acute form the application of a vacuum electrode to the throat externally for five or ten minutes, either by loose contact or by a mild spark will greatly aid the customary medical measures. Ozone inhalations and diathermy advised.
    Leucorrhea. The treatment is by means of the vaginal vacuum tube according to the method outlined in Chapter VII.
    Three to six treatments a week in connection with antiseptic and astringent douches will cure these cases.
    Tonic spinal sparks are advisable, frequently; also vibration.
    Leukemia. Prior to 1910 I believed high frequency currents were contra-indicated in leukemia because they increased leucocytosis.
    This I still consider true of vacuum tube applications (except orificial), but some experiments with auto-condensation have convinced me that in it we have a valuable aid in this disease. 2500 E. is the dose.
    The following case of splenic leukemia in an early stage, as shown by the blood count at the beginning of the applications and again a short time later, is one of the arguments that won my advocacy of the treatment.
    January 29, 1910, blood examination showed 3,360,000 red cells (89%); hemoglobin, 60%; white cells, 9,580 (135%; color index, .9. Besides variations in the proportion of normal white cells there were many poikilocytes and 1½% of myelocytes.
    June 3, 1910, the red cells had increased to 4,200,000 (97%); hemoglobin, 90%; white cells, 7,860 (100%); color index, 1, Poikilocytes and myelocytes entirely absent.
    I believe X-ray is the best remedy we possess in alternation with arsenic, and there is no reason why auto-condensation should not be employed with both.
    Lichen Planus. Use a vacuum tube in loose contact with the lesion, following the general technique outlined under Skin diseases in Chapter VI. X-ray in connection.
    Lichen Rubra has yielded to the same treatment as that for lichen planus.
    Lithemia. (See Gout.)
    Locomotor Ataxia. (Tabes Dorsalis.) Relief of pain and improvement in gait is accomplished in many cases of locomotor ataxia. I always employ heavy spinal vibration in connection with high frequency. Apparent cures in occasional cases where even the pupillary reflex has returned has caused me to believe that we sometimes diagnose cases of multiple neuritis as tabes.
    In multiple neuritis we have absence of the knee-jerk, and if the nerves of the eye were involved less of pulpillary reflex and diplopia might be present, which would apparently indicate locomotor ataxia, as the latter is the more frequently met with. This would also account for cases in which no evidences of syphilitic infection are obtained.
    In genuine cases of tabes a cure need not be looked for by this or any other method that we are at present acquainted with, but marked relief is not unusual.
    I use as sharp sparks as the patient will tolerate, along the spine, over buttocks, abdomen and to the back of the legs, followed by ten or more minutes on the auto-condensation couch or pad, 2500 E.
 

    Anesthetic areas call for short stimulating applications of the spark and also of mechanical vibration, while hyperesthetic places will call for prolonged applications of mild sparks and vibration.
    Daily treatments at first; gradually decreasing to three times a week.
    Low Blood Pressure. (See Hypotension.)
    Lumbago. Immediate relief follows the use of either high frequency or vibration in this form of muscular rheumatism.
    With the muscles "on the stretch" apply sharp sparks over the painful area. As the pain eases have the patient assume a different position in order to again excite pain and proceed as before until any posture may be assumed.
    Customarily I precede the high frequency with prolonged (inhibitive) vibration, but the order is of no importance.
    Localized auto-condensation is a good method to employ; also direct D'Arsonvalization, that is, diathermy.
    In an acute case the treatment may be repeated every three or four hours if necessary. In chronic cases three to six treatments per week. The length of each treatment is regulated by the time required to afford relief. Do not stop until you do give relief.
    This may be ten minutes or it may be half an hour.
    The use of high candle power lamps producing a great deal of heat will be found effective in conjunction with the above method.
    Lupus. In lupus the Finsen light and the X-ray are probably superior to high frequency, but it has been so successful that it should be employed in connection with the X-ray.
    The technique consists in the use of a sharp spark to get its escharotic effect. Caustic fulguration may be used, as this is essentially the action of a sharp vacuum tube spark.
    Nodules are successfully destroyed by this method.
    Sometimes it is desirable to keep a tube of considerable intensity in light contact with the lupus instead of employing the sharp spark.
    When fulguration is employed await the result of one treatment before another is given.
    When a short application of the spark is made it may be used after each X-ray treatment.
    The use of carbon dioxide show is a quick and satisfactory method of treating lupus.
    Mastoiditis. (Mastoid abscess.) Ordinarily I would consider it unwise to resort to any method outside of surgery for mastoid abscess.
    I have succeeded in a few cases with the X-ray, and in a good many have employed the ray after operation, where the later was not wholly successful and obtained excellent results and in these cases I made use also of the high frequency current in connection with the ray.
    A special tube for the mastoid is illustrated in Fig. 22 (the upper tube).
    The following quotation from Strong is pertinent:
 
    "In a severe case of mastoid abscess with cerebral and pyemic symptoms, a vigorous thirty-minute treatment with the white-vacuum electrode applied externally and a metal electrode in the mouth of the patient, produced an absolute dispersion of the acute manifestations, the patient sleeping naturally inside of five hours. The next day the pus was withdrawn, and although cover-glass preparations showed countless numbers of streptococci and staphylococci, but a few scattered colonies were obtained in a plate culture on nutrient gelatin."

    Menopause. High frequency currents are particularly suited to alleviating the various nervous symptoms that accompany "change of life."
    The most satisfactory method is auto-condensation, 2,500 E. three times a week.
    In the absence of an auto-condensation couch make application with a mild spark along the spine; to the back of the head and neck; and over the abdominal organs, taking fifteen or twenty minutes for the treatment.
    Special symptoms that are present call for the treatment outlined under the appropriate heading, such as constipation, headache, etc.
    Menorrhagia. (See Metrorrhagia.)
    Metrorrhagia. Treatment of this condition has been successfully accomplished through the introduction of a copper electrode into the cavity of the womb, protecting the vagina by means of a rubber tube.
    As these currents have shown an emmenagogue effect it is to be presumed that their opposite action in this case is due to the electrode being used within the uterus.
    The cases cited were reported by Franchon-Villeplee in the Bulletin of the French Electrical Society, February, 1905.
    The direct D'Arsonval (Diathermy) current seems best suited to metrorrhagia or menorrhagia.
    Migraine. Temporary relief in "sick headache" may be obtained by prolonged treatment over the seat of the pain, which usually involves one-half of the head.
    Use a tube capable of producing a half or three-quarter inch spark, but keep it in light contact with the surface. When treating through the hair, in women it may be necessary to let the hair down or to reduce the strength of the current because the thickness of the hair may cause too sharp a spark.
    Migraine is probably a toxic headache due to imperfect metabolism (sub-oxidation). This clearly indicates the advisability of auto-condensation.
    Long treatments, fifteen to twenty minutes or even longer, if during the attack; if between attacks, fifteen minutes three times a week. Dose, 2,500 to 7,500 E. or more.
    Moles, Moth Patches, Etc. Caustic fulguration is used for moles or moth patches (chloasma).
    Use care and avoid destroying too much tissue. See technique for fulguration, Chapter VI.
    The indirect Tesla spark with the fulguration tube is preferred by many for the removal of moles and warts.
    Molluscum Contagiosum. The method of treating this skin disease is with the vacuum tube, following the general technique outlined in chapter VI.
    Muscular Rheumatism. (See Rheumatism.)
    Myxedema. On account of its effect on metabolism auto-condensation has been used in the treatment of myxedema.
    Daily treatments of 2,500 E.
    Nasal Catarrh. For this condition the nasal tube is used within the nose with a mild current, treating for three or four minutes on each side, followed by an application to the nose externally with one of the surface electrodes.
    Inhalations of ozone are of the greatest importance.
    Nasal Diseases. Many diseases of the nose are benefitted by the use of high frequency currents.
    The technique is given under the appropriate heading, as ozena, etc.
 

    A number of different nasal vacuum tubes are shown in Figs 20-24.
    Nephritis. (See Albuminuria.)
    Nervous Debility. (See Neurasthenia.)
    Neurasthenia. Numerous cases of nervous exhaustion have been reported cured by high frequency currents. When the blood pressure is high, auto-condensation, 2,500 E. daily, is usually sufficient. The average number of treatments required is from twenty-five to forty.
    When the blood pressure is low auto-condensation is contra-indicated and tonic sparks to spine, back of head and neck and over solar plexus are appropriate.
    Ozone is a desirable adjunct, and in selected cases, vibration.
    Neuralgia. Application for the relief of neuralgia are made with a vacuum tube carrying current sufficient to produce a one-half or three-quarter inch spark.
    Ordinarily it should be passed back and forth over the painful area, in light contact with the skin. At times it is advisable to raise the tube and apply a sharply counter-irritant spark which will quickly redden the surface.
    I remember the old definition of neuralgia, as "the cry of starved nerve for blood," and certainly the high frequency will supply this want.
    In addition to the local treatment, auto-condensation or spinal sparks should be applied in accordance with the state of the blood pressure.
    The diathermic currents on account of the heat generated are advantageously employed. See Chapter XI.
 

    Various names have been given to indicate the different forms of neuralgia as facial neuralgia, ovarian neuralgia, etc.
    The treatment is essentially the same for all varieties.
    High candle power lamps may be used in connection with high frequency.
    Neuritis. In neuritis we have an inflamed condition of a nerve, the pain simulating that of rheumatism or neuralgia. Any nerve may be involved. Brachial neuritis is a common form.
    The high frequency current is positively curative in all cases, but must be used judiciously.
    Sharp sparks must not be employed at first, but a mild sedative current should be applied. This means that the tube should not carry more than enough current to produce a quarter-inch spark and should then be kept in comparatively close contact with the surface.
    It should be explained to the patient that the first few treatments sometimes aggravate the pain.
    After this stage is passed mild or medium sparks may be used, but if employed in the start the pain often will be so great that the patient may abandon the treatment.
    I always give auto-condensation, 2,500 E., in connection with the local application, unless the blood pressure is quite low. Many cases have been reported cured by this general treatment alone.
    Recently the diathermic or heat currents have been shown to be very satisfactory in the treatment of neuritis, and the use of the ultra-violet ray.
    Obesity. The treatment for obesity is auto-condensation, 2,500 to 7,500 E., or more. Patients lose from four to fourteen pounds per month in some instances.
    In those that do not show as great an actual reduction in weight there seems to be a re-distribution, so to speak, of the fat, which greatly increases bodily comfort.
    Superfluous fat is a result of imperfect metabolism and that is why auto-condensation is beneficial.
    Cormelles has noted a greater tolerance of thyroid extract after auto-condensation has been employed.
    Vibration is indicated and the method of Bergonic with special faradization chair.
    Opacity of Cornea. (See Corneal Opacity.)
    Orchitis. In the acute form we seldom have an opportunity of employing these currents, although with a portable coil it may be possible to do so if there is electricity in the patient's home.
    In sub-acute orchitis the vacuum tube is used with a mild effleuve or spark.
    Guilleminot recommends the diathermic current, one pole over the testicle and the other over the spermatic cord. The X-ray is advised, protecting the other testicle with lead-foil or treating through a speculum attached to a protective shield.
    Otitis. In all forms the application of a mild current through a vacuum tube inserted in the ear will be found beneficial, alone or in connection with other methods.
    In chronic suppurative otitis the X-ray is advised, also an ozone spray. This latter is sometimes administered through an eustachian catheter.
    Ozena. Atrophic Rhinitis. Application with the nasal tube, and the inhalation of ozone, summarize the methods of treating this disease with high frequency.
    Papilloma. The technique of fulguration for the destruction of papillomata is given fully in chapter VI.
    Paralysis. In general the treatment of this symptom calls for the application of the vacuum tube along the course of the paralyzed muscles, employing a current strong enough to produce a half or three-quarter inch spark. Part of the time keep the tube in contact with the skin and part of the time raise it above the surface to get the effect of the spark.
    Bi-polar Tesla treatment is excellent and also D'Arsonval surgings (See Chapter VI).
    The value of galvanism and faradism must not be forgotten and vibration is certainly useful.
    Paralysis Agitans. Cases of paralysis agitans benefitted by auto-condensation or auto-conduction have been reported. 2,500 to 7,500 E. or more.
    Two cases which I treated for a short time did not show any perceptible improvement.
    Paralysis, Infantile. (See Infantile Paralysis.)
    Paralysis of Sphincter Ani. Tousey reports marked improvement produced by fifteen treatments. Rectal applications and sparks to spine.
    Pelvic Abscess. Use the vaginal vacuum tube for seven minutes, repeating daily or twice a day; also mild applications externally over pelvic region.
    Diathermy advised. See Chapter XI.
    Pelvic Adhesions. Intra-vaginal vacuum tube treatment and mild spark over abdominal area. Three to six treatments per week. Vibration advised in conjunction. The D'Arsonval current is preferred by some operators either by the direct method or by auto-conduction, while others prefer the bi-polar Tesla current.
    Pelvic Exudates. The same technique is followed as in pelvic adhesions.
    Periostitis. The vacuum tube carrying a medium intensity of current is passed lightly back and forth over the diseased area for from five to ten minutes, three times a week, followed by a few minutes' application of the X-ray, or the high candle power light.
    Condenser electrodes are preferred by some operators.
    Pharyngitis. In the acute form diathermy is useful in combination with customary remedies, or the vacuum electrode may be employed.
    In the chronic form the spark may be used to destroy the follicles in the throat. See fulguration, Chapter VI, for technique.
 

    Phlebitis has been relieved by mild vacuum tube applications, keeping the tube in light contact with the skin. Customary methods should be kept up at the same time.
    Piles. (See Hemorrhoids.)
    Pityriasis. Follow the general technique given for skin diseases in Chapter VI.
    Pleurisy. Treat through a layer of two of clothing, using a medium intensity of current (one-quarter or one-half inch spark) and apply over both the front and back of the chest, keeping up the treatment for a long time until marked reddening of the skin indicates a proper degree of counter-irritation, three treatments a day if necessary in the beginning, in conjunction with usual medicinal methods. Chronic forms call for ozone and usually for the X-ray.
    Pneumonia. The high frequency treatment of pneumonia is the same as that employed in pleurisy, as given in the preceding section. In addition the inhalation of ozone by ozonizing the air of the room is absolutely essential and always should be employed from the start.
    It is much more sensible to administer this form of oxygen throughout the disease than it is to administer oxygen as a last hope in extremis.
    Post-fracture Conditions. The local application of the vacuum tube discharge in conjunction with vibration is of great benefit in restoring a normal condition of the parts. Its physiological action clearly indicates its value here.
    Post-operative Conditions. Here the current may be applied as given in the preceding section or it may be employed by means of auto-condensation or a general vacuum tube application for its tonic effect.
    2,500 E. Daily at first; later two or three times a week.
    Proctitis. In the chronic forms of this disease the direct D'Arsonval current (diathermy) is advised, using a metal electrode in the rectum, while a metallic electrode is held by the patient. Ten minutes, three to six times per week.
    Vacuum electrodes with Tesla or Oudin currents may be used.
    Prolapse of Rectum. Use a mild spark over the prolapsed tissue which almost always will cause an immediate contraction. If it does not, replace and follow with a seven-minute intra-rectal treatment. Three to six applications per week.
    Prostatic Diseases. The results following the high frequency treatment of all forms of prostatic disease are extraordinary.
    One authority found in a large series of cases over 85% were cured. In my own experience the apparent cures have been over 90% with no case in which perceptible improvement was not present.
    In enlarged prostate I was of the opinion that recent cases and those with an inflammatory infiltrate were all that could be reduced, but I have had positive reduction take place in a few cases of senile hypertrophy and I believe the possibilities in these cases are worthy of investigation.
    The technique is described in Chapter VII. In Fig. 55 is shown a special form of insulated vacuum tube for prostatic treatment originated by Dr. Samuel Stevens. My spatulate tube is shown in Fig 27. I use vibration in conjunction with high frequency in nearly all of my cases, and diathermy is advised in acute cases.
    Pruritus (Itching). This annoying symptom ordinarily is relieved by the high frequency effleuve or spark. Generally speaking the vacuum tube spark is employed as sharp as the patient will tolerate, but not for a long time. In other cases light contact with the tube is desirable, giving longer treatments than with the spark.
 

    In itching skin diseases the spark is very grateful to the patient and relief is immediate though often temporary.
    Pruritus ani. Treat with spark for 30 to 60 seconds and then use rectal tube for a six or seven minute treatment. Three to six applications per week.
    Pruritus vulvae. The vaginal vacuum tube is used first for seven minutes, followed by a medium spark externally over the itching surface. Daily treatments if possible.
    These cases frequently are caused by irritating vaginal or uterine discharges or by too acid urine. For the first use alkaline douches and for the latter give alkalies internally and see that plenty of water is drunk.
    Psoriasis. This is treated by the same technique as that employed in eczema.
    Purpura rheumatica. This form of purpura has been successfully treated by auto-condensation.
    Pyorrhea alveolaris. (Rigg's disease.) In this common but intractable disease of the gums the current is locally applied by means of special tubes. See chapter XII.
    The disease is very difficut to cure and high frequency is beneficial because germicidal in character as well as nutritional.
    Seven-minute daily treatments with tube in contact with the gum, using adjustable socket handle so that the patient may hold the tube in place.
    See complete discussion of technique in chapter XII.
    These cases always call for general treatment usually of an antacid character.
    Auto-condensation is suitable on account of its constitutional effect and its marked influence on elimination.
    Ozone by inhalation or by means of the local use of an ozone spray is directly indicated.
    Pyosalpinx. Intra-vaginal applications of the current have proved effective in some cases of pyosalpinx. Seven-minute treatments three or more times per week.
    Raynaud's disease. I have had no experience with this disease, but French operators report successful treatment. Auto-condensation was employed 2,500 E. or more.
    The number of seances varied from twelve to one hundred and twenty-five, an in the longer cases the treatment required about two years.
    Rectal diseases. Many diseases of the rectum have been treated with apparent success, by means of these currents. The general technique is given in Chapter VII.
    Among the diseases are included proctitis, fissure, hemorrhoids, prolapse of rectum, pruritus ani, paralysis of sphincter, etc. the method of treating each is given under its appropriate heading.
    Renal calculus. Dr. J. O. Chase reports the dissolving of renal calculus by means of auto-condensation. A metal electrode was placed over the abdomen, instead of the patient holding the handles. 2,500 to 7,500 E. daily. Diathermy relieves the pain.
    Retinitis. The method employed is the use of the double eye tube as in Fig. 47, or using a tube with a mild amount of current in light contact with the eye-lids, eye-brows and temple.
    In 1902-4 I treated successfully a number of diseases of the eye with high frequency and X-ray, in connection with Dr. G .F. Suker, at whose suggestion these methods were employed. Among these was one case of retinitis pigmentosa.
    Rheumatism. High frequency currents are of exceptional value in muscular and in chronic articular rheumatism.
    In the acute articular form the results have not been so satisfactory.
    Articular rheumatism, also known as inflammatory rheumatism or rheumatic fever, is known at the present time to be an infectious disease. Ordinarily the attack is ushered in by a sore throat and the infection enters by way of the tonsils. It affects fibrous and serous tissues in particular and one reason for believing the disease infectious is the similarity between the symptoms and those of gonorrheal rheumatism where a known infection causes the pain, etc. Frequently abscessed teeth are the foci of infection.
    Rheumatism is often confounded with rheumatic gout. It quickly produces impoverishment of the blood (anemia), and this is one reason why auto-condensation has proved so beneficial.
    In the acute form, both articular and muscular, the application of high candle power lamps is advised in connection with high frequency, and in the chronic type, vibration is a valuable adjunct. Diathermy recommended.
    In muscular rheumatism, of which lumbago, stiff neck, etc., are common types, the vacuum tube is used with either a mild or sharp spark and during the application the patient changes position frequently to keep the muscles on the stretch and to ascertain whether this posturing causes pain. The treatment is persisted in until relieved whether it be ten or thirty minutes.
    In chronic rheumatism the best treatment is auto-condensation, 2,500 to 7,500 E. daily, and vaccines.
    During the first treatments the symptoms may be somewhat aggravated, but after the second or third week improvement is steady and rapid.
    Vacuum tube treatment over the painful area may be used in connection with auto-condensation if desired, but a cure will result without this aid.
    Where the operator has no couch or pad prolonged mild treatments with the vacuum tube may take the place of auto-condensation. In this case the application should last at least twenty minutes.
    The amount of uric acid in the urine is immediately increase by auto-condensation, which probably accounts for the aggravation of symptoms in rheumatism and gout where long treatments are given in the beginning.
    Dr. J. P. Sutherland, Dean of Boston University school of Medicine, furnishes the following report: "The patient commenced treatment Dec. 24, 1905, but the first analysis was not made til Dec. 31, 1905"
 

Date	Total Urea.	Per cent. of Urea to Total Solids	Total Uric Acid.	Ratio of Uric Acid to Urea
Dec. 31, '05	19.56 grammes	29.8 per cent.	1.44 grammes	1 to 13.5
Jan. 4, '06	28.66 "	36.1 "	1.11 "	1 to 21.3
Jan. 9, '06	26.96 "	46.5 "	1.001246 "	1 to 26.96
Jan.13, '06	27.32 "	42.8 "	.7649 "	1 to 35.7
Jan. 19, '06	26.24 "	40.2 "	.667 "	1 to 39
		(Normal about) 45 per cent.	(Normal .5)	(Normal 1 to about 35 to 40)

 
    Williams reports one case in detail where the ratio of uric acid to urea was 1 to 51.5 before treatment. At the end of one week it had increases to 1 to 63.5; and at the end of the second to 1 to 70.3, from which point it rapidly decreased, being 1 to 64.8 at the end of the third week; fourth, 1 to 46.7; fifth, 1 to 41; sixth, 1 to 34.5. Patient's weight increased six and a quarter pounds during this time.
    Both of the cases cited show the remarkable effects of auto-condensation in increasing elimination.
    Rhinitis (Atrophic). (See Ozena.)
    Riggs Disease. (See Pyorrhea alveolaris.)
    Ring-worm. (See Tinea.)
    Rodent Ulcer. The method of treating rodent ulcer is the same as that employed for epithelioma, (q. v.).
    Scars. (Cicatrices.) Vacuum tube sparks have a softening effect on scar tissue. Even contact with the tube without sparking has a similar tendency (as in treating strictures).
    If the spark is made very sharp and therefore caustic or escharotic, or if caustic fulguration is used, the scar tissue will be destroyed and pliable new tissue takes its place.
    For small scars about the face the application of a medium spark (one-fourth to one-half inch) is recommended, the treatment repeated in five to eight days if fulguration is employed. (See Chapter VI for technique.)
    If a vacuum tube spark is used the treatment may be repeated daily or every other day until a sufficient degree of irritation has been set up.
    Sciatica. Apply the vacuum tube along the course of the nerve and over the lower part of the spine. Use enough current to produce a spark from one-half to one inch in length, but ordinarily do not raise the tube from the skin. Give a ten or even fifteen minute application, repeating daily or every other day.
    I nearly always follow this with auto-condensation, 2,500 Eberharts.
    Seborrhea. For dandruff or any seborrheic condition the vacuum tube is used, carrying enough current to give a quarter to a half-inch spark. It is then kept in light contact with the surface treated and passed back and forth about ten minutes; repeating three to six times per week.
    Seminal Emissions. For nocturnal emissions sparks to the lower part of the spine are advised, followed by a seven-minute treatment of the seminal vesicles by means of the rectal tube.
    Sinusitis. In frontal sinusitis I have on a number of occasions applied the vacuum tube over the sinuses, keeping it in light contact, although employing a medium intensity of current. This was always in connection with vibration.
    Ths first time I gave this treatment it was for the purpose of affording temporary relief until the patient could arrange to consult a specialist as I believed operative interference necessary. I almost questioned my diagnosis when informed the following day that the pain had practically disappeared.
    Subsequent experience shows that this result may be obtained in a fair proportion of cases that are seen early in the disease.
    If relief is not afforded by one or two treatments, the sinus should be drained by a competent rhinologist.
    Skin Diseases. The vacuum tube effleuve or spark is one of the most useful agents in treating a number of skin diseases.
    The general technique is outlined in chapter VI., while special methods are indicated under a number of the diseases, to which reference may be made.
    The high frequency current should be in the office of every dermatologist. It benefits practically the same class of skin diseases that the X-ray has been employed in.
    Sore Throat. (See Pharyngitis and Laryngitis.)
    Sprains. Use a vacuum electrode and with a moderate intensity of current. Keep the tube in light contact while rubbed gently back and forth over the sprain. A long treatment; fifteen or twenty minutes; repeating in two or three hours if necessary.
    Sterility. General tonic treatment by auto-condensation or by the vacuum tube is to be employed together with local treatment with the mild spark over the region of the ovaries or testicles. In women intra-vaginal treatments are indicated, and in men the use of the glass urethral tube has seemed to exert a beneficial influence, although results in these cases are uncertain.
    Stiff Neck. (See Torticollis; also Rheumatism.)
    Stricture of the Urethra. I have had excellent results in a large number of cases of stricture treated by means of the urethral electrode. The general technique is given in chapter VII.
    Three to six treatments a week are advised.
    This method will not cure every case and galvanic electrolysis; dilation under anesthesia; or operative measures may be required.
    Sub-involution. The use of an intra-uterine electrode with the direct D'Arsonval current (diathermy), as explained under metrorrhagia, is the method which gives the best results in sub-involution, although vaginal vacuum tube applications have proved efficacious.
    Suppuration. Vacuum tube applications always tend to limit suppuration.
    Where a suppurating area is accessible the ozone spray is the best application which can be made to it.
    Sycosis. In barber's itch and other forms of sycosis the X-ray is our best method, but it may be advantageously supplemented by application of the spark from the vacuum tube, used in accordance with the tolerance of the patient. Mild fulguration also may be employed.
    Synovitis. Treat as directed for sprains, that is, use vacuum tube without a spark, for a long sedative application in the acute form, or use the diathermic current, 600 to 1,200 milliamperes.
    For the chronic case, short, thick, counter-irritant sparks are required.
    Tabes Dorsalis. (See Locomotor Ataxia.)
    Throat Diseases. High frequency currents are useful in connection with routine methods in laryngitis, pharyngitis, etc. See Chapter VII for general technique. A number of throat electrodes are illustrated in Figs. 20 to 23.
    Tic Douloureaux. Trigeminal neuralgia has been successfully treated by applications of the high frequency current, one operator reporting the cure of a case where resection had failed. Prolonged application over the course of the nerve with a medium intensity of current, but without producing a spark. Diathermy is indicated.
    Tinea. In ringworm and in all forms of tinea the X-ray is the best treatment supplemented by vacuum tube applications, either by direct contact or by a reasonably sharp spark.
    Tinnitus Aurium. The administration of the current through the ear tube as outlined in Chapter VII has proved curative in cases of "ringing in the ears."
    I always employ vibration in conjunction with the high frequency.
    Tonsillitis. The throat has been treated externally with the vacuum tube in tonsillitis, following the method suggested under pharyngitis and laryngitis. It is only of value in connection with our usual methods, and is not advised as the sole treatment. Diathermy is recommended.
    Tonsillotomy. I have seen a number of reports of the successful destruction of the tonsils by means of fulguration.
    Judd says "For the removal of the tonsils we have in this agent an ideal method. It is bloodless, not very painful and avoids the danger of hemorrhage in fibrous growths."
    Torticollis. Wry neck or stiff neck in an acute or sub-acute form is cured by vacuum tube applications along the sterno-cleido-mastoid muscle.
    A long application with a tube capable of emitting a half-inch or inch spark, kept in light contact with the skin or applied through a sufficient number of layers of cloth to get short, sharp, thick sparks.
    Trachoma is successfully treated by using the eye tube in connection with the X-ray, or using a tube exhausted to a vacuum high enough to give off some X-rays.
    Tuberculosis of Glands. In the treatment of tuberculous glands, the vacuum tube spark is employed in combination with the X-ray. High frequency without X-ray is not advisable for this condition.
    Any surface or condenser electrode may be used with an intensity of current capable of producing a one-half to one inch spark. The tube may be used in light contact with the skin or slightly separated to give a short but comparatively thick spark. This may be regulated by treating through a sufficient thickness of cloth. Five to ten minute applications. The best method is to give a seven minute X-ray treatment three times a week followed by the high frequency application. Ozone strongly advised.
    Tuberculosis of the Peritoneum. Tuberculous peritonitis is treated by the local application of the vacuum tube over the abdominal area or by localized auto-condensation. The effleuve from a diaphragm electrode may be used.
    I prefer general auto-condensation, 2,500 E. daily, with mild vacuum tube spark applied through a layer of clothing. Ozone indicated.
    Tuberculosis (Pulmonary). In local forms of tuberculosis the X-ray is superior to high frequency; but in pulmonary tuberculosis conditions are reversed and in auto-condensation and ozone we have two remarkably effective remedies which should be understood better by the profession.
    My attention was directed to the use of auto-condensation in this disease by Chisholm Williams' book in which he reported thirty-two out of forty-three consecutive cases as symptomatically cured, this being about 75%.
    Previous to this time I employed the X-ray, using with it vacuum tube or diaphragm applications of high frequency.
    I am now convinced that either auto-condensation or auto-conduction is superior to other forms of high frequency in this disease.
    Ozone is especially effective in consumption and if I could only have one remedy I would prefer to take my chances with ozone. It must not be limited to inhalations at the physician's office, but the air of the patient's room must be thoroughly ozonized, so that he or she is constantly getting a suitable amount in the air they breath. If they can only respire one-half as much air as formerly, but that amount by reason of the ozone is twice as powerful in oxidizing properties, the proper balance is maintained.
    Williams observed that the use of auto-condensation was followed at first by an increase in symptoms. The expectoration increased, the cough was more frequent but easier; there was a lower morning but a higher afternoon temperature; and an average loss of weight of about a pound a week during the first three weeks. The concurrent use of ozone shortens this first stage.
    After this period improvement was steady, although some attenuated tubercle bacilli were present long after all other symptoms had disappeared.
    On account of the rise in temperature produced by auto-condensation we must be careful not to give too long a treatment at the beginning if the patient is carrying a comparatively high temperature, for instance, 103 degrees or over, or is in an advanced stage of the disease.
    The reaction is similar to that from tuberculin. The rise in an already high temperature might be too great if a long treatment was given. For this reason it is a good plan to give five minutes on the auto-condensation couch or pad and then await the subsidence of the reaction before giving the second treatment. I would not employ more than from 1,000 to 1,250 E. in the first three or four treatments, after which the patient will quickly establish a tolerance for the treatment and the dose may be increased to 2,500 E. or more. As soon as this period is reached daily applications are urged and should be followed by spinal sparks to offset the blood-pressure reducing effect of the auto-condensation.
    In cases that carry very little temperature at the time of starting treatment, a ten-minute daily application may be made from the beginning.
    The direction for the use of ozone and reports of its remarkable effects will be found in Chapter IX.
    I have made it a rule to send the specimens of sputum to a reliable laboratory for examination, thus having the proof of the value of the treatment made by a disinterested party.
    The following gives a comparative idea of the improvement taking place in an average case:
    Mrs B., Jan. 2, 1908. Many tubercle bacilli present. Other organisms not numerous. Staphylococci; diplococci of catarrh; fibrin, mucus; pus cells.
    April 8, 1908. Tubercle bacilli few, averaging about seven to the microscopic field. Bacilli deep-staining, showing extremely few vacuolated forms. Phagocytosis very prominent; clumping not prominent. Other organisms noticeably absent.
    The specimen was so remarkable in the marked degree of phagocytosis and the absence of other organisms that the physicians in charge of the laboratory took occasion to call me up and ask the nature of the treatment employed.
    Two months later this patient was so well that she refused to continue the treatment, having regained her normal weight and strength, although an occasional bacillus was still to be found.
    The value of ozone and of auto-condensation is so marked and so easy of demonstration that I am surprised the methods are not better known, and in general use in institutions for the treatment of consumption.
    They possess the advantage not only of being curative in themselves but also of not preventing the use of all the established methods of treatment in connection with them. They afford two additional non-interfering methods of equal value with any used, and thereby increase the patient's chances to that extent.
    Ulcers. (See Chronic Ulcers.)
    Urethritis. The directions for treating specific urethritis will be found under gonorrhea. Non-specific forms yield to the same methods.
    Uric Acid conditions. All methods of employing high frequency currents aid in eliminating both urea and uric acid, but auto-condensation and auto-conduction are especially effective.
    Their value can be tested readily and is easy to ascertain by a few urinalyses.
    Urticaria. (Hives.) Vacuum tube applications using a medium spark or with the tube in contact with the surface is the method of treatment.
    Speaking of the value of high frequency currents in skin diseases, Dr. C. W. Allen says in the Medical Record: "The vaso-motor effects may be well studied in urticaria. Here sparking the wheal produced entire disappearance of the lesion, which is replaced in a few moments by a balanced area.
    Vascular redness soon returns, the area of this being larger than the lost wheal. The effect of contraction followed by dilatation is very marked. The spray soothes the itching. Internal measures are not to be neglected."
    Uterine Diseases. Treatment through the vagina to the womb has been beneficial in cervicitis, endometritis, etc. The general technique is given in Chapter VII. High frequency currents are always indicated in inflammation of any mucous membrane. (See Cervicitis.)
    Vaginitis, whether simple of specific, is treated according to the technique given under gonorrhea in the female.
    Varicocele. A medium spark applied over the scrotum has been used, also immersion of the scrotum in a glass vessel with metallic connection to one pole of the D'Arsonval circuit, the other held in the hand. The current may be applied with two metal electrodes so placed as to include the varicocele between them. My own opinion is that the only real cure for varicocele is the radical operation.
    Varicose Ulcers. "Long, thick, muscle-toning, high potential sparks over the affected limb; on the spinal centers, and upon the general muscle masses of the entire body for alterative, nutritional, circulatory benefits are indicated." (Monell.)
    Warts and other small growths may be removed by fulguration, as described in chapter VI.
    Writer's Cramp. This is an occupation neurosis variously known as piano player's cramp, telegrapher's cramp, etc. It is the result of repeated use of the same muscles to the point of exhaustion and chronic fatigue. The vacuum tube is used with a current sufficient to produce a quarter or half-inch spark. The tube is kept in light contact with the skin and the application is made from the finger tips to and including the shoulder area, brachial plexus and upper spinal centers. For the latter the tube is raised to obtain a stimulating spark, and I frequently employ the spark for the whole treatment. The use of vibration in conjunction is strongly urged. Three treatments a week.
    Many authorities advocate general eliminative treatment in connection, such as auto-condensation or electric light baths.
    Wry Neck. (See Torticollis.)